Written by a parent, not a doctor. Nothing here is medical advice.

Childhood Cancer Lantern
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Tennessee program

Children’s insurance above the TennCare line (CoverKids)

CoverKids is Tennessee’s children’s insurance for families above the TennCare income line.

What it is

CoverKids is Tennessee’s children’s insurance for families above the TennCare income line.

CoverKids can cover a child whose income is too high for ordinary TennCare. The same application checks TennCare first. Enrollment in a comprehensive work plan usually blocks CoverKids, but an offer of that plan alone does not.

Eligibility rules
  • Your child must be under 19, live in Tennessee, and meet the citizenship or immigration rules for the coverage dates. Tennessee changes the noncitizen test on October 1, 2026. TennCare can review your child’s status, any waiting-period exception and notices.
  • The published 2026 base limit is 250% of poverty: $5,692 a month for three people or $6,875 for four.
  • With the state's allowance, a family of three can qualify up to about $5,806 a month and a family of four up to about $7,013.
  • Comprehensive employer or state employee coverage blocks enrollment. An offer without enrollment does not.
  • A plan bought on HealthCare.gov does not count as other insurance for CoverKids, but a comprehensive work plan does. Ask the counselor about the start date and the cancer team's network before dropping either.
  • The immigration rules are the same as for TennCare: a citizen child qualifies, and for other children the counselor checks the child's own status.
What you get
  • No monthly premium. Copays can apply to some services.
  • Medical, medicine, dental and vision coverage under the CoverKids plan’s care rules.
What the help covers
  • There is no premium. Whatever the copays, your family never pays more than 5% of its yearly income in CoverKids cost sharing; keep receipts and ask the plan how to log them.
  • Copays depend on which of three cost levels your child is placed in. At the highest level a clinic visit is $15, a specialist $20, a generic medicine $5 and a brand-name medicine $20 to $40; at the middle level those are $5 or less, and at the lowest level everything is free.
  • A hospital admission costs at most $100, and a non-emergency visit to the emergency room at most $50. Dental, vision and therapy visits are at most $15.
  • Preventive care, immunizations, annual eye exams, lab/X-ray, emergency emergency-room care, home health and ambulance have $0 copays at all levels. Pregnancy-related enrollees and hospice services have further exemptions. Your plan can explain those exemptions and the benefit limits; CoverKids does not carry Medicaid’s full EPSDT entitlement.
If you decide to apply
  1. If you decide to pursue CoverKids, the financial counselor can help with TennCare Connect.
  2. Current income and details of every plan your child has or has been offered help with the review.
  3. The counselor can check your cancer team, medicines, copays and the timing of any insurance change.

TennCare Connect: 1-855-259-0701 · Official page ↗

After you ask
  • The state checks ordinary TennCare before CoverKids.
  • Children have 12 months of continuous eligibility, with listed exceptions.
Good to know

Coverage starts on the application date or when all eligibility conditions are met, whichever is later. It does not cover earlier months. The counselor can confirm the start date before you change existing insurance.

Other details
  • A completed, signed application matters, but coverage cannot start before all eligibility conditions are met. The state’s effective-date notice is the date to use when coordinating an existing plan.

Federal background: Children’s Health Insurance Program.

Official sources
Ask your social worker

“Would CoverKids cover the cancer team and medicines our child needs? What copays or insurance tradeoffs should we expect, and could you help us apply if it fits?”

Why I’m asking: I want to compare the cost and coverage before changing our child’s insurance.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

File on TennCare Connect and say your child has no other plan. Send the pay stubs the state asks for.

Your social worker

The oncology social worker files with you and checks which plans the oncology group is in.

The care team

Records and letters when the application asks for them.

Who decides
TennCare checks the income and the category; the health plan you pick runs the coverage.
Ask your social worker
“Can we file the CoverKids application today, since cover starts from the day it arrives? Which plans is the oncology group in?”

How to apply

First step: Discuss whether this route fits your child’s care and existing coverage with the social worker. If you choose it, the financial counselor can help with TennCare Connect and the relevant dates.

  1. Discuss whether this route fits your child’s care and existing coverage with the social worker. If you choose it, the financial counselor can help with TennCare Connect and the relevant dates.
  2. Ask which health plans the oncology group is in before you choose one.

Official application / program page ↗

Where it starts: The same application as TennCare: tenncareconnect.tn.gov or 1-855-259-0701. The state checks TennCare first.

What to gather

  • Child’s birth certificate or ID and Social Security number
  • This month’s income for the household
  • Proof your child is not enrolled in another plan

How long: The joint application usually has a 45-day decision standard. Coverage begins on the later of application or satisfaction of all eligibility conditions.

What a yes looks like

A notice naming CoverKids, a start date and a health plan to choose. Twelve months of continuous coverage follows.

What a no looks like, and the next move

Ask whether it was income, other insurance or citizenship. If your child is enrolled in a work plan, ask what dropping it would change before you touch it.

Watch out

  • Being offered a work plan does not shut you out; being enrolled in one does.
  • Coverage starts on the later of the application date or the date all eligibility conditions are met. It does not cover months before application.
  • The eligibility policy excludes Marketplace qualified health plans from the other-insurance test. The counselor checks coverage transitions, subsidies and the cancer-team network.

Dates that change this

2025-11-01: The dated policy manual says a Marketplace plan does not count as other insurance; the public questions page still says CoverKids must be your only plan. The manual is the more specific document. Ask the caseworker to put the answer in writing. (not yet confirmed against the final rule)

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

Children’s insurance with no monthly premium, up to $6,875 a month for a home of four. Copays can apply to some services.

  • $6,875/month — Upper limit, home of 4 (250 percent of poverty)
  • $5,692/month — Upper limit, home of 3 (250 percent)
  • $0/month — Monthly premium

Covers: Hospital and clinic care · Chemotherapy and prescriptions · Specialist care through the health plan you choose

Legal protection: Twelve months of continuous coverage once a child is approved, with listed exceptions

What it costs the family: No monthly premium. Copays can apply to covered services and prescriptions.

The eligibility facts, as published

Age
under 19
Age max exclusive
19
Income
at or below 250 percent of the poverty line; the five-point allowance would lift it to 255 percent but those dollar cells are not published
Other insurance
enrollment in comprehensive employer or state employee coverage is a bar; an offer alone is not; the dated manual treats a Marketplace plan as not other insurance
Citizenship
United States citizen, national or eligible non-citizen
Residency
Tennessee
Continuous eligibility
12 months, with listed exceptions
Retroactive months
none: coverage starts from the completed signed application

Decisions this site cannot make: TennCare Connect income determination; the TennCare category is checked first

Expect friction on: Coverage starts from the signed application, so there is no look-back to cover old bills · Each health plan builds its own specialist network

The trap: An employer-plan offer alone does not block CoverKids, but enrollment can. Coverage starts no earlier than the later of application or satisfaction of all eligibility conditions.

Where I read this

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